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 

  1. Emergency
    care
    : patients involved in accidents, suffering from serious illness
    and immediately require specialized care

  2. b.
    Primary care
    : Involves preventive health   maintenance  and evaluation and management on     confirming basic general discomfort,
    early   complaints , symptoms and
    other aspects of disease

  3. 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

  1. Providing
    general medical services

       Preventive
services

       Curative

       Follow
up of discharged patients

       Rehabilitation

  1. Family
    welfare services and  counseling

  2. 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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