DRUG DISTRIBUTION: Pointers for newbies

Deals with drug distribution from the ‘Main’ pharmacy to the various pavilions (nursing stations, wards etc…).

Methods :• Individual prescription method• Floor stock system• Individual prescription method + Floor stock system • Unit Dose Dispensing (UDD).

INDIVIDUAL PRESCRIPTION METHOD : In smaller hospitals w/ inpatient facility. Prescription written by the prescriber is carried to the wards. Advantage – Pharmacist directly handles the prescription.

FLOOR STOCK SYSTEM : 2 types of drugs – Charge floor stock drugs, Non-charge floor stock

drugs.

Charge Floor Stock Drugs : Drugs given to the patient, that are charged to the patient’s OWN

account.

Non-charge Floor Stock Drugs : No direct charge to the patient. Charges are levied to the ‘daily’ ward bill.

Advantages : Ready availability of required rugs. Elimination of drug returns. Reduction in the number of drug-ordered transcriptions for the

pharmacy. Reduction in the number of pharmacy personnel required.

Disadvantages : Medication errors may increase (medication orders are NOT reviewed

by the pharmacist). Increased drug inventory on the pavilions

Disadvantages (contd.)

Greater opportunities for pilferage and wasting. Increased hazards associated with drug deterioration. Increased work load for the nurses. More capital required (in the absence of proper storage facilities).

INDIVIDUAL PRESCRIPTION METHOD + FLOOR STOCK SYSTEM : Followed in some hospitals. Drug stock in the wards will be less.

Selection of Charge floor stock drugs : PTC makes the decision. Pharmacist must ensure that the selected / approved drugs are

available in the various pavilions ASAP. Examples –• Injectable charge floor drugs (Antiallergenic injectables;

antibiotics; anticoagulants; antihypertensives; CV agents; antiepileptics; antinauseants).

Selection of Non-charge floor stock drugs : Following considerations are to be made –• Cost of preparation• Frequency of use.• Quantity used.• Effect upon the hospital budget.

PRESCRIBING FLOOR STOCK DRUGS Physician writes the prescription. A carbon copy of the prescription is sent to the pharmacy. The physician’s order is transcribed by the hospital personnel

assigned to the nursing station.

LABELLING Charge floor stock drugs TO WARD ___________ (Name or Number) NAME OF THE PREPARATION FORMULA NAME OF HOSPITAL

Non-charge floor stock drugs TO WARD ___________ (Name or Number) NAME OF THE PATIENT NAME OF THE PREPARATION NAME OF HOSPITAL

PHARMACIST’S ROLE1] Envelope method : Envelope is the ‘carrier’ for the drug. Name and quantity of drug; patient’s name is written on the

envelope. Nurse dispenses from this envelope to the patient, if prescribed by

the physician. Envelope is sent back to the pharmacy and the charges levied

accordingly.

2] Drug basket method : Requires an inventory of the nursing units to which the drugs are

sent. Nurse takes inventory of the all the drugs in the nursing unit (at

day’s end). This report is placed in the basket, which is then sent to the

inventory. Next day – pharmacist refills it and sends it back to the nursing

units.

3] Mobile Unit : Nursing unit send a copy of drug requisition order to the

pharmacy. Drugs are dispensed via the Mobile Unit. Mobile Unit –• Stainless steel; ht. (60 in.); width (48 in.); depth (25.5 in.).• Main body is mounted on six 8 in. balloon wheels (central wheel is

stationary; other wheels are rotating type).• 2 locking, sliding doors w/ handle for pushing.

4] Unit Dose Dispensing (UDD): All those medications which are ordered, packed, administered,

charged in multiples of single doses, and which contain a pre-determined amount, needed for a single application.

2 types – Centralized Unit Dose Dispensing (CUDD) Decentralized Unit Dose Dispensing

(DUDD)

CUDD No ‘flow’ or ‘satellite’ pharmacies. Only central pharmacy. Drugs are dispensed via mobile carts and ‘dumb’ waiters.

DUDD Satellite pharmacies (storage for the drugs).

Advantages : Improved p’ceutical care to the patient. Patients are charged only for the medications administered to

them. P’cist packs all the medications which are required in the nursing

stations (this allows the nurse more time for patient care). Eliminates credits; reduces pilferage, drug wastage and revenue

costs. Reduces the storage space in the nursing units.

Introducing UDD in hospitals : Purchase all equipments needed to pack UDD. Adjusting w/ other hospitals. Purchasing all the drugs in UD packages.

UDD PROCEDUREAdmission Patient details are entered in patient profile card

Physician orders the medication, after examinations

P’cist receives copies of the medication order

Medications are entered into the patient profile card

P’cist checks the medications ordered ( for allergies; DIs and rational Tx)

Drugs are sent to the nursing stations via medication carts

Nurse administers the medication and enters into medication records.

Cart is re-checked by the p’cist upon return to the pharmacy

(if the drugs ordered were administered to the patient or not)

THANK YOU