Drug Distribution System
Drug Distribution System
Content
• Different hospital drug distribution systems
• Central sterile supply system in hospital
• Purchasing and warehousing procedure
Objective
After completion of this lecture, student will be able to:
• Describe the different hospital drug distribution systems
• Explain hospital central sterile supply system
• Explain purchasing and warehousing procedure
Drug Distribution System
DEFINITION:
• Supply of drugs in the hospitals and other clinics for the treatment of indoor and outdoor patients by indent system
In-patient Services
Types
• Individual prescription order system
• Complete floor stock system –
Charge floor system and
Non charge floor stock system
• Combination of individual drug order and floor stock system
• Unit dose dispensing system
• Charge non-floor stock system
Individual Prescription Order System
• Used by small and private hospitals because of reduced man power requirements
• Physician writes the prescription for individual patient who obtains the drugs prescribed by paying own charges
Advantages:
• Medicines orders are directly reviewed by the pharmacist
• Provides interaction with pharmacist and other medical staff and patients
• Provides clear control of inventory
The Complete Floor Stock System
• Often used in the government hospitals
• The drugs are given to the patients through nursing stations and the pharmacy supplies from the drug store of the hospitals
• Drugs on nursing station or ward may be divided into
a) Charge floor stock drugs
b) Non charge floor stock drugs
Charge floor stock drugs:
• Medicines (stocked in nursing stations) are charged to the patient’s account after they have been administered
• Selection of “charge” stock drugs: Decision as to which drug shall be placed should rest with the PTC
• The list of drugs may vary from hospital to hospital
• In the same hospital the list of drugs may change from time to time as per the recommendations of the PTC
e.g. Antiallergics-hydrocortisone sodium succinate
Antibiotics-penicillin G.
mannitol injections, dextrose 50%, 25%
Non charge floor stock drugs:
• Used by patients in unit ward and for which there may be no direct charge to the patient’s account
• Cost of this group of drugs, is calculated as, per day cost of room or ward
Selection of non-charge stock drugs:
• Consideration is given to
-the cost of preparation,
-the quantity used, and
-effect on hospital budget
-reimbursement from third party payers
(Employees’ state insurance scheme)
• It varies from hospital to hospital
Ampoules: Digoxin, Adrenaline
Tablets: Aspirin, Paracetamol
Advantages:
• Easy and fast availability of drugs
• Elimination of returns of drugs to the store or pharmacy
• Reduction in number of drug transcriptions for the pharmacy
• Reduction in the number of pharmacy staff required
Disadvantages:
• Increase in medication error (due lack of review of medicines order)
• Greater chances of pilferage
• Increase drug inventory in the ward
• Greater work load for nurses
• Increase drug deterioration
• Lack of proper storage facilities
Drug basket system:
Used currently by hospitals for stocking non charge floor stock drugs and selected products in the wards
Mobile dispensing unit:
Used in hospitals to take medications to the patients bedside for carrying out dressings and also drugs to be administered
Combination of Individual Drug Order and Floor Stock Systems
• Uses individual prescription as primary means of dispensing but also utilize a limited floor stock
• Most commonly used in hospitals of our country
• Modified to include use of “unit medications”
Unit Dose Dispensing System
• Those medications which are ordered, packaged, handled, administered and charged in multiples of single dose units
• These single doses containing a predetermined amount of drug or supply sufficient for one regular dose, application or use
Procedure
Depending upon the hospital and its pharmacist’s choice. They are:
• Central unit dose drug distribution system (C.U.D.D.)
• Decentralized unit dose distribution system (D.U.D.D.)
Centralized Unit Dose Dispensing
• Inpatient drugs are dispensed in unit doses
• Drugs are stored in a central area of pharmacy
• Dispensed at the time the dose is due to be given
• Medication carts and waiters are needed
• Necessary to send a copy of original medn. order to the pharmacy for the direct interpretation and dispensing
Decentralized Unit Dose System
• Operates through small satellite pharmacies (A branch of main pharmacy) located on each floor of the hospital
• Wards obtain their required drugs instead of going to the main pharmacy
• Main pharmacy feeds the medicines to the mini pharmacies
• The delivery system is accomplished by use of medication carts
Advantages of Unit Dose Dispensing
• Improved pharmaceutical services for the patients
• Allow the pharmacist to interpret a copy of medn. order there by reducing medication error
• Eliminates labeling mistakes, duplication of order and paperwork at nursing area and Pharmacy
• It transfers I.V. preparations and drug reconstitution procedures to the pharmacy
• It eliminates pilferage or drug waste by partial usage of drugs
• It can save the time both in pharmacy and nursing service
• Promotes efficient utilization of professional and non-professional personnel
Dispensing of Charge Non Floor Stock Drugs
• Ordering, dispensing and accounting of drugs consume a lot of time on nursing services and pharmacy personnel
• One method adopted to identify the patient is the charge plate prepared on the admission to hospital where the nursing time is saved
• All newly printed hospital forms usually reserve a suitable place in the upper right or left hand corner of the form for information on the identification plate (plastic or metal card)
• All charge stations are equipped for using this time saving device which yields an important by-product viz. legibility of identity
• Items with an extremely heavy demand have specific card with all the information pre-printed
• All that is necessary is the patient’s identity which is quickly supplied through the use of the charge plate
The Envelope System
• In this system, an envelope may be used to dispense drug to the wards
• It can also be used to indicate the charges for the drugs for the patients to pay
Bed Side Pharmacy
• They are essentially locked medication drawers
• Located in patient servers
• Specially designed supply closets build into the hall wall at the entrance to each patient’s room
Central Sterile Services
• Operates centrally
• Supplies entire requirement of sterile materials of the hospital and all things needed to the sterile area of the hospital (operation theatre)
• Includes non sterile materials needed to the operation theatre
Out-patient Services
• The term out door patients or ambulatory patients refers to patients not occupying beds in hospitals or those who are not admitted in the hospitals or to other in-patient settings
They are of three types
- Emergency care: patients involved in accidents, suffering from serious illness and immediately require specialized care
- b. Primary care : Involves preventive health maintenance and evaluation and management on confirming basic general discomfort, early complaints , symptoms and other aspects of disease
- c. Tertiary care: servers rendered to patients who have been advised to go the hospitals by doctor, primary health centers and dispensaries
Objectives of Out-patient Services
- Providing general medical services
• Preventive services
• Curative
• Follow up of discharged patients
• Rehabilitation
- Family welfare services and counseling
- Health education
Location of Out Patient Dispensing
• In majority of hospitals the out-patient’s dispensing is done from the same dispensary whether for outdoor or indoor patients
• Three equally suitable provisions are made for this area:
A. A separate outpatient pharmacy may be set up
B. Combined in-patient and out-patient unit service provided from the same window
C. Combined in-patient and out-patient unit service provided from separate window
The Dispensing Routine
• Prescription written by the doctor
• Taken by the patient to the pharmacists
• The prescription and the label are numbered
• The directions and pertinent information are entered on the label
• A check for accuracy is conducted
• Finally the container is handed to the patient giving them directions, regarding the proper use of the preparations supplied
Dispensing to Emergency Patients
• Dispensing of drugs to emergency ward of a hospital is carried out after the patient receives treatment in that ward and is given a prescription
• Hospitals use special cabin containing medication bins which stores selected and limited quantity of drugs packaged in these bins
• The system provides for punched cards containing information on the drug and are used for billing and re-ordering purposes
Summary
• Drug distribution system is Supply of drugs in the hospitals and other clinics for the treatment of indoor and outdoor patients by indent system
• There are 5 types of distribution systems.
• Objectives of out-patient services.
• Dispensing to emergency patients.
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