Dispensing To Inpatients Lecture Notes PDF

Dispensing to Inpatients PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Systems of Inpatient dispensing Central and Satellite pharmacy Unit dose dispensing Self medication programs ...

Dispensing to Inpatients PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Systems of Inpatient dispensing Central and Satellite pharmacy Unit dose dispensing Self medication programs  Inpatient Dispensing Why inpatient dispensing  Reduce the nursing time consumption for frequent visits to pharmacy  Drug dispensing is a pharmacy act and consists of the pharmacist removing two or more doses from a bulk drug container and place them in another container for subsequent use.  Drug administration is a nursing act which consists of the removal or withdrawal of a single dose from the drug container and its administration to a patient on the order of a physician or dentist  Inpatient Dispensing ASHP guidelines  Before the initial dose of medication is administered the pharmacist should review the prescriber’s original order or a direct copy.  Drugs dispensed should be as ready for administration to the patient as the curre nt status of the pharmaceutical technology will permit, and must bear adequate identification including; name or names of drug, strength, or potency, route(s) of administration, expiration date, control number, and such other special instructions as may be indicated.  Facilities and equipment used to store drugs should be so designed that the drugs are accessible only to medical practitioner authorized to prescribe, to pharmacist authorized to dispense, or to nurses authorized to administer such drugs.  Inpatient Dispensing ASHP guidelines  Facilities and equipment used to store drugs should be designed to facilitate routine inspection of the drug prior to the time of administration.  When utilizes automated (mechanical/electronic) devices as pharmaceutical tools, it is mandatory that provision be made to provide suitable pharmaceutical services in the event of failure of the device  ASHSP pronounced that the pharmacist in charge shall be responsible for specifications both as to quality and source for purchase of all drugs, chemicals, antibiotics, biological and pharmaceutical preparations used in the treatment of patients.  Since the pharmacist has the responsibility for the compounding, dispensing and manufacture of the drugs used in the hospital, he should also have the authority to specify the drugs used to be purchased  Inpatient Dispensing ASHP guidelines  Mechanical or electronic drug storage and dispensing devices, as require or encourage the repackaging of drug dosage form from the manufacturer’s original container, should permit and facilitate the use of a new package, which will assure the stability of each drug and meet USP standards for the packaging and storing of the drugs, In addition to meeting all other standards of good pharmacy practice  Inpatient Dispensing Different systems of dispensing  There are four systems in general for dispensing drug for inpatients. They may be classified as follows; i. Individual prescription order system ii. Complete floor stock system iii. Combination of (i) and (ii), and iv. The unit dose system.  Inpatient Dispensing Individual Prescription Order System  This system is generally used by the small and/or private hospital because of the reduced manpower requirement and the desirability for individualized service. Inherent in this system is the possible delay in obtaining the required medication and the increase in cost to the patient.  At the same time there are very definite advantages: A. All medication orders are directly reviewed by the pharmacist B. Provides for the interaction of pharmacist, doctor, nurse and patient and C. Provides closer control of inventory.  Inpatient Dispensing Complete Floor Stock System  Regardless of the size of the hospital or specialty of care a supply of drugs is stored in the medicine cabinet of the nursing unit which is serviced by a unit dose system. And the drug stored in the nursing station depending upon the specialty of care is term as floor stock drugs. It should be in minimum quantity.  Drugs in the nursing station may be divided into: a) Charged floor stock drugs,  Envelope method / Charged plate b) Non-charged floor stock drugs.  Drug basket method  Mobile dispensing unit  Inpatient Dispensing Complete Floor Stock System  Advantages i. Ready availability of the required drugs; ii. Elimination of drug returns; iii. Reduction in the number of drug order transcriptions for the pharmacy iv. Reduction the number of pharmacy personnel required.  Inpatient Dispensing Complete Floor Stock System  Disadvantages i. Medication errors may increase because the review of medication orders is eliminated; ii. Increased drug inventory on the pavilions; iii.Greater opportunity for pilferage (to steal small items of little value, especially habitually); iv.Increased hazards associated with drug deterioration; v. Lack of proper storage facilities on the ward may require capital layout to provide them vi.Greater inroads (a gradual violation) are made upon the nurses’ time.  Inpatient Dispensing Complete Floor Stock System  Envelope method i. Prefilled envelopes – Predetermined quantity on nursing units  Post administration it is charged on patients  Like emergency carts  Inpatient Dispensing Complete Floor Stock System  Drug Basket Method i. Basket with medicine containers which is replenished on timely basis  Mobile Dispensing unit i. Utilizes specially constructed mobile unit consisting of shelves ii. Always under supervision of professional personnel iii.Routine checking of stocks  Inpatient Dispensing Combination of Individual Prescription Order and Complete Floor Stock systems  Falling into this category are those hospital which use the individual prescription or medication order system as their primary means of dispensing, but also utilize a limited floor stock. This combination system is probably the most commonly used in hospitals today and is modified the use of unit dose medications.  A list of non-charge and charged floor stock is prepared on the basis of following criteria:  The cost of preparation  The frequency of use  The quantity use  The hospital budget  Inpatient Dispensing Unit Dose Dispensing System  The unit dose system of medication distribution is a pharmacy-coordinated method of dispensing and controlling medications in health care institutions.  It is defined as- 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, dose application or use.’  Types A. Centralized unit-dose dispensing (CUDD) B. De-centralized unit dose dispensing (DUDD) – Satellite Pharmacies  Inpatient Dispensing Unit Dose Dispensing System  The unit dose system may differ in form depending on the specific needs of the institution. However, the following distinctive elements are basic to all unit dose system:  Medications are contained in a single unit packages  They are dispensed in as ready-to-administer form as possible  For most medications not more than a 24 hours supply of doses is delivered to or available at the patient-care area at any time.  Safer for the patient  More efficient and economical for the institution,  More effective method of utilizing professional resources.  Inpatient Dispensing Unit Dose Dispensing System  Advantages of Unit Dose System  Patient receive improved pharmaceutical services 24 hours a day and are charged for only those doses which are administered to them.  All does of medication required at the nursing station are prepared by the pharmacy thus allowing the nurse more time for direct patient care  Allows the pharmacists to interpret or check a copy of the physician’s original order thus reduction the incidence of medication errors  Eliminates excessive duplication of orders and paper work at the nursing station and pharmacy.  Inpatient Dispensing Unit Dose Dispensing System  Advantages of Unit Dose System  A reduction in the size of drug inventories located in patient-care areas (eliminates bulky floor stock)  Greater adaptability to computerized and automated procedure regarding medication orders and delivery system.  The pharmacists can get out of the pharmacy and onto the wards where they can perform their intended function as drug consultants and help providing the team effort that is needed for better patient care.  Inpatient Dispensing Unit Dose Dispensing System  Advantages of Unit Dose System  Decrease in the total cost of medication related activities  Transfers intravenous preparation and drug reconstitution procedure to the pharmacy  Improved overall drug control and drug use monitoring  More accurate patient billing for drugs  The elimination or minimization of drug credits  Greater control by the pharmacist over pharmacy workload patterns and staff scheduling  Inpatient Dispensing Unit Dose Dispensing System  Centralised unit-dose dose dispensing (CUDD):  All in-patient drugs are dispensed in unit doses and all the drugs are stored in central area of the pharmacy and dispensed at the time the dose is due to be given to the patient on or minimization of drug credits  Drugs are transferred from the pharmacy to the indoor patient by medication cards.  Inpatient Dispensing Unit Dose Dispensing System  Decentralized unit dose dispensing: (DUDD): - Satellite Pharmacies  This operates through small satellite pharmacies located on each floor of the hospital  Advantages:  Disadvantages:  Easy for the administration staff.  High cost.  Accounting becomes easier in certain cases.  Consumes more time and doubtful.  Better stability of the products  Occupy more space for storing.  Ex-Eno-fruit salt in sachets.  Ledger posting and inventory control problem  Inpatient Dispensing Step-by-Step outline of Unit Dose Procedure 1. Upon admission to the hospital, the patient is entered into the system. Diagnosis, allergies and other pertinent data are entered on to the patient profile card. 2. Direct copies of medication orders are sent to the pharmacist 3. The medication order are entered on to the patient profile card 4. He pharmacist checks medication order for allergies, drug interaction, drug interactions, drug laboratory test effects and rationale of therapy 5. Dosage schedule is coordinated with the nursing station  Inpatient Dispensing Step-by-Step outline of Unit Dose Procedure 6. Pharmacy technician picks medication orders, placing drugs in bins of transfer cart per dosage schedule 7. Medication cart is filled for particular dosage schedule delivery. 8. Pharmacist checks cart prior to release 9. The nurse administers the medication and makes appropriate entry on the medication record 10. Upon return to pharmacy, the cart is rechecked 11. Throughout the entire sequence, the pharmacist is available for consultation by the d octors and nurses. In addition he/she is maintaining surveillance for discontinued ord ers.  Inpatient Dispensing Other concepts  Patient servers  Drawers in hallway for each wards  Advantage for access but expensive  Pill pick systems  https://www.youtube.com/watch?v=8WFIKfqJYvw  Robotic dispensing  https://www.youtube.com/watch?v=CmFIhAb1fDQ Thank you