Pharmacy Practices in Dispensing

New Concepts in Dispensing

• Pharmacists can play a key role in ensuring drug safety by working on the nursing station, ordering, stocking and preparing drugs for administration and consulting clinical and nursing staff.
• Pharmacists are trained and licensed to deal with all aspects of drug selection and handling, aside from administering it to patients.
• On the pavilion, pharmacists can help physicians in choosing the most appropriate treatment, assisting nurses with interpreting physician orders and in preparing doses, and managing drug storage and control.

Dispensing to Ambulatory Patients

• As ambulatory care activities increase within hospitals, hospital pharmacists are becoming more involved in providing services to these patients.
• Hospital pharmacists are creating innovative services for ambulatory patients including specialized patient information brochures, patient-dosing calendars, specialized packaging, and patient education.

Location of Out-Patient Dispensing Area

• Three suitable provisions for out-patient pharmacy locations:
  • Separate out-patient pharmacy
  • Combined in-patient and out-patient unit with service provided from the same "window"
  • Combined in-patient and out-patient unit with service provided from separate “window”
• A separate out-patient pharmacy is usually established when the out-patient department and pharmacy are geographically separated.
• Advantages of a separate out-patient pharmacy include a specialized function and distinct unit, but it requires a separate staff and consumes a great deal of time for pharmacy department personnel to transport supplies and drugs.

Types of Prescription Received

• The types of prescriptions received in the out-patient department pharmacy typically include those from private patients, indigent patients, non-indigent patients, employees, and patients being discharged from the hospital.

The Dispensing Routine

• The dispensing pattern for clinic patients and patients being discharged with "take home drugs" mirrors that of community pharmacies.
• A physician writes a prescription, the patient takes it to the pharmacy, the pharmacist numbers the prescription and label, places directions and information on the label, affixes ancillary labels, fills the container with the appropriate medication, checks for accuracy, wraps and dispenses the prescription.

Dispensing Ancillary Supplies

• A recent trend in hospital pharmacy involves assuming responsibility for the purchase, stocking, and distribution of various ancillary medical, surgical, and laboratory supplies.
• These supplies can include surgical instruments, catheters, sutures, needles, syringes, sphygmomanometers, and laboratory items.
• Whether or not this trend is desirable depends on the individual pharmacist and hospital administration.

Administration to the Patient

• Within the hospital, steps 4-12 constitute the hospital drug distribution system.

Methods Used in Transmitting Physician’s Medication Order to the Pharmacy

• The physician writes the medication order on a separate blank.
• The medical record has a duplicate copy for referencing.
• The physician’s order is transcribed by nursing personnel onto an inpatient prescription or requisition form.
• The order is transmitted to the pharmacy by the physician inputting it into a computer terminal.

Types of Drug Distribution

• Individual prescription for each patient
• A complete Floor Stock System
• A combination of 1 and 2
• Unit dose dispensing, either centralized in the pharmacy or decentralized at the nursing unit level
• A pharmacy coordinated unit-dose dispensing and drug distribution system.

Individual Prescription Order System

• Drug distribution system in which medications are dispensed by a pharmacist on receipt of individual medication orders.
• This system is generally used in small and/or private hospitals due to reduced manpower requirements and individualized service.

Individual Prescription Order System - Advantages

• Review of all medication orders by the pharmacist.
• Interaction between pharmacist, doctor, nurse, and patient.
• Closer control of inventory.

Individual Prescription Order System - Disadvantages

• Potential delays in obtaining medication.
• Increase in cost to the patient.

Floor Stock System

• Drug distribution system where drug supplies are stocked on nursing units.
• Rarely used or particularly expensive drugs are not included in floor stock and dispensed upon receipt of a prescription or medication order.
• This system is most often used in governmental and other hospitals where charges are not made to the patient or an all-inclusive rate is used.

Drugs on the Nursing Unit

• Drugs on the nursing unit may be divided into:
  • Frequently used drugs
  • Infrequently used drugs
• A list of frequently used drugs should be created and maintained by the pharmacy department.
• The list of frequently used drugs should contain the generic name and dosage forms of 10 to 20 of the most frequently used drugs on the nursing unit.
• The pharmacist is responsible for reviewing medication orders and maintaining an inventory of drugs.

Floor Stock System - Advantages

• Easy to implement and manage.
• Convenient for nurses.
• Allows for faster drug access.
• Provides a source for drugs that are not frequently used by nurses.

Floor Stock System - Disadvantages

• Potential for medication errors.
• Theft, loss and damage to drugs are more likely.
• Difficult to track drug usage – leading to higher wastage.
• Higher cost of inventory.

Unit Dose Dispensing

• A drug distribution system in which drugs are dispensed in individual, unit-of-use packages.
• Unit dose dispensing eliminates errors in calculation and reduces drug wastage by only providing a prescribed amount for each dosage.
• Unit dose packages are usually labeled with the patient’s name, medication, and dosage instructions, reducing the risk of errors.

Unit Dose Dispensing - Advantages

• Eliminates measurement errors by nurses.
• Reduces risk of medication error by pre-packaging.
• Improved inventory control and reduced drug wastage.
• Provides a safer and more accurate system of drug distribution.

Unit Dose Dispensing - Disadvantages

• Requires significant initial investment in packaging materials and equipment.
• Additional staff needed to manage the system.
• May be difficult to implement in older hospitals.
• Not practical for patients who require frequent dosage adjustments.

A Pharmacy-Coordinated Drug Distribution System

• A system that uses unit dose dispensing for pre-packaged medications and floor stock for other drugs.
• The purpose is to enhance the efficiency of the drug distribution process, reduce errors and wastage, and ensure that the right drug is provided to the right patient at the right time.

Other Drug Distribution Systems

• Other drug distribution systems are also used in hospitals but have less applicability.
• These systems are usually implemented when other systems are not feasible.

Conclusion

• It is important for pharmacists to be knowledgeable about the different approaches to drug distribution.
• This knowledge will help pharmacists improve the efficiency and safety of drug distribution in their healthcare setting.
• Pharmacists can ensure that patients will receive the right drug, at the right time, at the right dosage, based on their individual needs.

Explore the essential roles pharmacists play in drug safety and patient care, especially in ambulatory settings. This quiz covers various practices related to medication dispensing, including collaboration with healthcare professionals and innovative patient services. Test your knowledge on how pharmacists enhance treatment outcomes through effective dispensing techniques.