Drug Distribution System PDF

DRUG DISTRIBUTION SYSTEM UNIT VII Introduction One of the responsibilities of the institutional pharmacy practitioner is drug distribution. Currently, the major portion of a pharmacist’s time is spent in drug distribution, including IV preparation. Introduction I...

DRUG DISTRIBUTION SYSTEM UNIT VII Introduction One of the responsibilities of the institutional pharmacy practitioner is drug distribution. Currently, the major portion of a pharmacist’s time is spent in drug distribution, including IV preparation. Introduction In a hospital with over 200 beds, this occupies 71-74% of their item, compared to 16% in management tasks and 10-13% in clinical practice. Many administrators as well as other professionals view drug distribution as the primary reason for a pharmacist’s existence. Definition of Terms DRUG DISTRIBUTION SYSTEM a system that has its purpose in the selection, acquisition (from the manufacturer), control storage, dispensing, delivery, preparation and administration of drug products in health care institutions in response to the order of an authorized prescriber DRUG DISTRBUTION SYSTEM Syn: Medication Distribution System Drug Management System Drug Delivery System DISPENSING  The act of a pharmacist in supplying one or more drug products to a patient, usually in response to an order form an authorized prescriber, utilizing his professional knowledge, judgement, and skills to assess the patient and the drug and then plan, develop, control and monitor the maintenance and delivery of the drug along with the information needed for its proper storage and administration UNIT DOSE  a physical quantity of a drug product ordered by a prescriber to be administered to a specified patient at one time, in ready-to- administer form with no further physical or chemical alterations required UNIT DOSE PACKAGE  a package containing one dose SINGE UNIT PACKAGE  a package which contains one discrete pharmaceutical dosage form e.g. one tablet, one 5 mL volume of liquid STEPS IN DRUG DISTRIBUTION The overall drug distribution and utilization process in the hospital involves an infinite number of procedures, personnel, departments, equipment and storage. As an illustration, the drug distribution system can be summarized as a chain of twelve At the manufacturer: 1. Order processing 2. Production and filling 3. Shipping At the Pharmacy: 4. Ordering/Receiving 5. Storing 6. Prep’n for dispensing (compounding, measuring, packaging, labelling) On the Nursing Unit 9. Order/Receiving 10. Storing 11. Preparation for administration 12. 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 (1) The physician writes the medication order on a separate blank. (2) The medical record has a duplicate copy so that the pharmacy can obtain a carbon copy of the physicians’ original medication order. (3) The physician’s order is transcribed by the nursing personnel onto an inpatient prescription or requisition form. (4) The order is transmitted to the pharmacy by the physician inputting the order in a computer terminal. TYPES OF DRUG DISTRIBUTION 1. Individual prescription for each patient 2. A complete Floor Stock System 3. A combination of 1 and 2 4. Unit dose dispensing either centralized in the pharmacy or decentralized at the nursing unit level. 5. A pharmacy coordinated unit- dose dispensing and drug 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 by the small and/or private hospitals because of the reduced manpower requirements and the desirability for individualized service  INDIVIDUAL PRESCRIPTION ORDER SYSTEM ADVANTAGES: 1. All medication orders are directly reviewed by the pharmacist 2. Provides for the interaction of pharmacist, doctor, nurse and patient 3. Provides closer control of inventory INDIVIDUAL PRESCRIPTION ORDER SYSTEM DISADVANTAGES: 1. Possible delay in obtaining the required medication 2. Increase cost to the patient FLOOR STOCK SYSTEM  drug distribution system in which drug supplies are stocked on nursing units  Rarely used or particularly expensive drugs are omitted from floor stock but are dispensed upon the receipt of a prescription or medication order for the individual patient FLOOR STOCK SYSTEM  Although this system is used most often in governmental and other hospitals in which charges are not made to the patient or when the all inclusive rate is used for charging, it does have applicability to the general hospital DRUGS ON THE NURSING NIT MAY BE DIVIDED INTO: 1. CHARGE FLOOR STOCK DRUGS  May be defined as those medications that are stocked on the nursing station at all times and are charged to the patient’s account, after they have been administered to him  DRUGS ON THE NURSING NIT MAY BE DIVIDED INTO: 2. NON-CHARGE FLOOR STOCK DRUGS  represents that group of medications that are placed at the nursing station for the use of all patient on the ward and for which there may be no direct charge to the patient’s account  The cost of these group of drugs is usually calculated in the per diem cost of the hospital room FLOOR STOCK SYSTEM ADVANTAGES: 1. Ready availability of the required drugs 2. Elimination of drug returns 3. Reduction in number of drug order transcriptions for the pharmacy 4. Reduction in the number of pharmacy personnel required  FLOOR STOCK SYSTEM DISADVANTAGES: 1. Medication errors may increase because the review of medication orders is eliminated 2. Increase drug inventory on the wards 3. Greater opportunity for pilferage 4. Increased hazards associated with drug deterioration 5. Lack of proper storage facilities on the ward may require capital outlay to provide them 6. Greater inroads are made upon the nurses’ time COMBINATION OF INDIVIDUAL DRUG ORDER AND FLOOR STOCK SYSTEMS In this system, drugs which are free floor stock are charged against the nursing service and, in the final analysis, the patient does pay for the drugs since the cost is included as a part of the nursing service portion of the daily room and board rate UNIT-DOSE DISPENSING SYSTEM The unit dose drug distribution is a pharmacy coordinated system of dispensing and controlling medications in health care institutions Medications are contained in single-unit packages and are dispensed in ready-to-administer form as possible UNIT-DOSE DISPENSING SYSTEM For most medications, not more than a 24-hour supply of doses is delivered or available at the patient care area at any time A medication profile is maintained for each patient UNIT-DOSE DISPENSING SYSTEM ADVANTAGES: 1. Patients receive improved pharmaceutical service 24 hours a day and are charged for only those doses which are administered to them. 2. All doses of medications required at the 3. Allows the pharmacist to interpret or check a copy of the physician’s original order thus reducing medication errors. 4. Eliminates excessive duplication of orders and paper work at the nursing station and pharmacy 5. Eliminates credit 6. Transfers IV preparation and dry reconstitution procedures to the pharmacy 7. Promotes more efficient utilization of professional and non-professional personnel 8. Reduces revenue losses 9. Conserves space in nursing units by eliminating bulky floor stock 10. Eliminates pilferage 11. Extends pharmacy coverage and control throughout the hospital from the time the physician writes the order to the time the patient receives the unit dose 12. The pharmacist can get out of the pharmacy and into the wards where they perform their intended functions as drug consultants and help provide the team effort that is needed for The Unit Dose Dispensing may be introduced into the hospital in either of two ways: 1. Centralized Unit Dose Distribution System (CUDD)  All drugs are stored in a central area pharmacy and dispensed at the time the dose is due to be given to the patient 2. Decentralized Unit Dose Drug Distribution (DUDD)  Sub-pharmacies that receive their supplies from the main pharmacy but have the advantage of being able to respond to the clinical needs of the patient on a current basis  In addition, such a system makes available to the patient, physician and nurse the services of a pharmacist in a clinical capacity rather than a dispenser of medications. A PHARMACY-COORDINATED UNIT DOSE DISPENSING AND DRUG ADMINISTRATION SYSTEM This system differs from the others in that pharmacy technicians have been trained to administer the drugs instead of registered nurses. These pharmacy technicians assist in the unit-dose dispensing phase as well as the drug administration phase of the coordinated system which is directly controlled and supervised by registered pharmacists. Pharmacists work directly with physicians on the nursing unit to carry out pharmacy’s mainstream function of the safe and appropriate use of drugs in patients. This system reduce significantly the incidence of medication errors in comparison with the other drug distribution systems in existence. PATIENT SELF-ADMINISTRATION OF DRUGS IN HOSPITALS Pharmacists generally have considered a unit-dose dispensing system as a panacea for hospital drug problems. However, unit-dose dispensing systems primarily have been “pharmacy-centered” rather than “patient-centered”. The new direction in hospital pharmacy is to develop patient- oriented services as the focal point in drug-distribution systems. The self-administration of drugs by patients in the hospital offers many advantages. It allows the patient to assume more responsibility for his direct care and allows him to learn how to use drugs properly, and be able to anticipate potential side effects and other drug-created problems. Itprovides a salient opportunity for the pharmacist to help educate patients on the safe and proper use of drugs and thereby alleviates much time spent by nurses and physicians in this essential pharmct’l function. Self-administration of drugs by patient can be implemented effectively on numerous hospital services, such as obstetrics, surgery, medicine, physical A procedural manual should be prepared which outlines the methods used to implement a patient self- administration program as part of a unit-dose distribution system. A self-administration medication program gives the patient possession of his medication and makes the patient responsible for its administration. Both the nurse and pharmacist will make rounds to insure that the patient is using his medication properly. The self-administration program enables the nurse to use her time better. The patient should become more knowledgeable bout his medication, thus enhancing proper and safe use of drugs during hospitalization and after discharge. A nurse-administered medication This program is used for patients who are not capable of self- administering their medications and for those medications which the patient cannot administer to himself. This is the interacting role which hospital pharmacists have developed under the umbrella term, “clinical pharmacy”. There is a challenging professional role which the pharmacist can assume as a member of the health-care team. This role involves the safe and appropriate use of drugs in patients. Taken in a broad context, this implies a high-level role indeed. This is the main purpose for the existence of pharmacy as a health profession. Thus, the concept behind the clinical pharmacy movement is directed toward the development of this role as the main function of the profession. NEW CONCEPTS IN DISPENSING Much has been written about placing a pharmacist on the nursing station to assume all responsibility concerning the ordering, stocking and preparation of drugs for administration as well as to be readily available for consultation by the clinical and nursing staffs. This would be a desirable step forward in ensuring drug safety through marked reduction in medication errors. This would be possible because the pharmacist is sufficiently trained and legally licensed to deal with all aspects of drug selection and handling with the exception of administering it to the patient. On the pavilion, the pharmacist may help the physician in the selection of the most therapeutically beneficial drug, assist the nurse by interpreting the physician’s order as well as the preparation of each dose for administration, and the ordering, storage, charging and control of all drugs and related products on the nursing station. DISPENSING TO AMBULATORY PATIENTS As ambulatory-care activities continue to increase within the institutional setting, the hospital pharmacist becomes more and more involved in providing services to these patients. While these pharmacy activities parallel community-pharmacy practice, hospital pharmacy practitioners have developed many innovative services for the patient. This includes special patient information brochures, patient- dosing calendars, special packaging, patient education The activities previously mentioned will continue to increase as more emphasis is placed on ambulatory care as part of the total patient-care program by hospitals.  LOCATION OF OUT-PATIENT DISPENSING AREA  There is no set rule as to the best area to locate an out-patient dispensing pharmacy. This is evidenced by the fact that in today’s practice three equally suitable provisions are made for this area: a. Separate out-patient pharmacy is available b. A combined in-patient and out-patient unit with service provided from the same “window”  c. A combined in-patient and out- patient unit with service provided from separate “window” A separate out-patient pharmacy is usually established whenever the out-patient department and the pharmacy are geographically widely separated. Although this arrangement has the advantage of being a separate and distinct unit with a specialized function, it possesses the disadvantage of requiring a separate staff as well as consuming a great deal of time, on the part of the pharmacy department personnel, in transporting supplies and drugs to the area.  TYPES OF PRESCRIPTION RECEIVED Depending upon the location and kind of hospital, the prescriptions received in the out-patient department pharmacy will generally include those of private patients, indigent patients, non- indigent patients, employees, and patients being discharged from the hospital. THE DISPENSING ROUTINE The dispensing pattern involved in providing clinic patients as well as those patients being discharged with “take home drugs” is identical with that carried on by a community pharmacy. In both instances, a prescription is written by the physician and the patient takes it to the pharmacy. Once in the hands of the pharmacist, the prescriptions and label are numbered by a numbering machine; the directions and other pertinent information are placed on the label; ancillary labels are affixed; the proper medication is then placed in the container; a check for accuracy is then conducted; and finally the prepared prescription is wrapped and dispensed. For internal audit purposes, hospital prescriptions are separated into out-patient and in- patient discharges and therefore may utilize two different colored blanks. DISPENSING ANCILLARY SUPPLIES A recent trend in hospital pharmacy is the assumption of responsibility for the purchase, stocking and distribution of the various ancillary medical, surgical and laboratory supplies. These may consist of surgical instruments, catheter, sutures, needles, syringes, sphygmomanometers and laboratory things. Whether or not this is a desirable trend depends upon the individual pharmacist and the hospital administration. Certainly the assignment of this added type of responsibility to the pharmacist is a clear indication of the administration’s respect for his multiple talents. In addition, a few years of experience in handling these supplies will better qualify him to assume responsibility for the central sterile supply room or for the purchasing division if the occasion should ever arise. Because of the nature of ancillary supplies, they are usually purchased from sources other than a pharmaceutical house or wholesaler. The pharmacist must acquaint himself with the various agencies, distributors and general wholesaler. Since many distributors have the agency for the same product, it is wise to purchase as many items via the bid process with the right to bid being pen to all, but the specifications and other service demands associated with the shipping, billing, etc. being set at a level that only the most reliable vendors can meet. The purchasing of the supplies should not be mixed with the purchasing of pharmaceuticals and separate records and inventories should be maintained. END