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.
