Hospital and clinical pharmacy

1. 3.Drug distribution system in
hospital
Prepare By : Yannawar P.D. ( M.Pharm)
Dcop, Latur

2. Content
 Introduction
 Out patient service
 In patient service
 Drug distribution system in IPD
 Unit dose system
 Floor ward stock system
 Satellite pharmacy system
 central sterile service
 Bed side pharmacy

3.  Introduction
 A well planned and systemically arranged drug distribution system is extremely
important in hospital as it eliminates error which occurs during dispensing of drugs.
 Which ultimately reduces chances of drug interaction.
 The drug distributions in a hospital are distribution to the outpatients, the inpatients ,
Operation Theater and other services in hospital.
 The procedures of drug dispensing are categorized into two types:
1. Out patient service/Outdoor or ambulatory patient
2. Inpatient service/Indoor patients

4. Outpatient Drug Distribution System(ODDS)
 Definition of Outpatient:
An outpatient is the one who is not admitted in the hospital and offers consultation and diagnosis, receives
treatment and does not require bed or hospitalization.
 Classification of Outpatient:
TYPES DESCRIPTION EXAMPLE
General Outpatient A patient who comes to the hospital for treatment of
general symptoms like fever, cough, cold etc.
acute illness
Referred Or tertiary
outpatient
Directly referral from primary or secondary health
professionals.
Cancer treatment, cardiac,
plastic surgery
Emergency
Outpatient
the patient suffering from serious health or accidents
require immediate medical attention.
Major accident
Ambulatory or
primary Outpatient
the patient coming for maintaining the daily personal
health. patient who are able to ambulate or walk about.
Minor surgery, dental services,
dermatological service.

5. Continue..
 Following are the reasons for development of outpatient department (OPD) as a separate
function of hospital;
1. Demand by community
2. Lack of sufficient number of physician
3. Need pf hospital to support its inpatient teaching program
4. Hospitals more active role in community health program
 Advantages
1. Treatment commences immediately
2. medicine may prescribe as part of clinical trials
3. Medicine prescribed may be restricted to pharmacy

6. Location and layout of outpatients:
 Location of outpatients:
1. There is no specific rule for location of OPD, but some provisions are
2. separate outpatient dispensing pharmacy
3. It should be located near the office & main entrance of the hospital.
4. It must be located on ground floor.
5. It should have a pleasant look.
6. The floor should be smooth & easily washable.

7. Layout for OPD
 OPD contain following department:
1. Office
2. Waiting Room
3. Window for Dispensing
4. Consulting room
5. Store

8. • Drug distribution to outpatient
 No medication should be issued without prescription
 After the issue has been made quantity supplied must be recorded
 Medicines are given to outpatient from the pharmacy situated outpatient block

9. In-Patient Distribution System (IPDS)
 Definition
The Patients who gets admitted in the wards of the hospital or occupies the beds in the hospital.
 Objective:
To provide drugs for all inpatients of hospital on 24 hrs per day basis
To inspect and control the distribution of drugs in all treatment areas

10. Drug distribution system in IPD (IFCU)
1. Individual Prescription Order System
2. Floor Stock System/Ward stock system
i. Charge floor stock system
ii. Non-charge floor stock system
3. Combination of above 2 methods
4. Unit Dose Dispensing System(UDDS)
a. Centralized Unit dose Drug Distribution System (CUDDS)
b. Decentralized Unit dose Drug Distribution System (DCUDDS)

11. 1. Individual Prescription Order System
 This system is mostly adopted in small hospital or private clinics.
 The medicine is dispensed either by the pharmacist or under his direction
 Advantage
 Reduce manpower requirement
 All prescription directly reviewed by pharmacist
 Medication error can be spotted
 Disadvantages
 Increase in cost of drugs to patients
 Cannot practiced in big hospitals

12. 2.Floor / ward Stock system
 Drugs are kept at the nursing unit, where drug are stored prior to preparation and
administration.
 Types of floor stock system
Floor stock system
Charge floor stock system non charge floor stock system
Drug basket method Mobile dispensing unit

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14. Dispensing of charge floor stock system
 The patients are charged mostly because of high cost of drugs
 These includes injection or single dose preparation
 Envelope is used to dispense the drugs to nursing station which is used as charge ticket.
 The pre labeled envelope are filled with specific drugs in a specified quantity and placed at
nursing unit
 When drug is administered, the patient name and room number is entered on the envelop and
sent to pharmacy.

15. Dispensing of Non Charged floor stock system
 It is done by 2 methods for dispensing of non charged or free floor stock system
A. Drug basket method
B. Mobile dispensing unit
 Drug basket method
 The nurse check the supplies against master list provided by pharmacy
 Nurse fill the requisition form for delivery of drugs at their floor
 When there is empty container, the nurse place it in the drug basket.
 The pharmacy staff fills each container and dispense requested ampoules and vials as ordered.
 Once the basket is completed, it deliver to floor.

16. Mobile dispensing unit
 It is specially constructed stainless steel body of the dimension.
 Height- 60 inch width- 48 inch depth – 25 inch
 The pharmacist controlling mobile unit check the items and quantity left in the pavilion drug
cabinet.
 The carbon copy of requisition for floor stock supplies is left on pavilion as record of delivery
and original is return to pharmacy.
Automated dispensing unit

17. Advantages and disadvantages
 Advantages
 The deterioted, outdated and non approved drugs and drug sample may be removed quickly
through routine checking, hence eliminate drug returns
 Nursing station drug cabinet are under continues supervision of pharmacist
 Ready availability of drugs
 Reduce pharmacy personnel
 Disadvantages
 It consume pharmacy personnel's time
 Inventory of pavilion drug cabinet has to be done by pharmacist

18. Selection of charge floor stock drugs
 PTC committee decide about selection of drugs to be kept in charge floor stock
 After fixing floor stock it is responsibility of hospital pharmacist to make drug available
 The following type of drugs are usually stocked in the hospital
 Injectable
 Antibiotics
 Antiepileptic's
 Antihypertensive
 Anticoagulants
 Cardiovascular agents
 Diuretics
 Anti- allergic
 Misllaneuos

19. Selection of non charge floor stock drugs
 Quantity of drugs to be used
 The frequency of use
 Cost of drugs
 Effect on the hospital budget.
 The list of drugs should be prepared by considering need of staff and type of patient

20. Dispensing of controlled drugs

21. 3.Combination of above two methods
 This system followed in government hospital and also in private hospital who run on the basis of
no profit and no loss
 Individual prescription or medication system is followed as major means
 In this system drugs are in frequent use are supplied as ward stock and other drugs are
individually dispensed when required.
 In this method there is combination of both individual prescription order system and floor stock
/ward system

22. 4. Unit dose dispensing system (UDDS)
 Those medications which are ordered, packed, handled, administered and charged in the form of
 multiples of single dose unit containing a predetermined amount of drug called Unit dose dispensing.
 Advantages of UDDS
1. This system minimizes the wastage of drugs.
2. Each dose is readily available; hence the patient receives medicines round the clock.
3. Less chances of medication error.
4. It reduces contamination of drugs as they are properly pre-packed.
5. Less paperwork, so that, more space is available on nursing station and pharmacy.
6. Patients are charged only for the dose they receive.
7. Keeping an account of drugs becomes easier at the pharmacy.
8. The system enables proper financial control in pharmacy.
9. Reduction in nursing time and maintenance of record is simple.
10. Accurate delivery of medicines due to repackage of drugs with name, strength and expiry date, helps
in avoiding wrong administration.
11. Packages that are not opened are reused.

23. There are two Types of UDDS
1. CENTRALIZED UDDS
• All unit doses are stored in the central pharmacy
• It is dispensed at the time of dose administration to the patients
• The Medication carts containing information of the unit dose are sent to the physicians as well as pharmacy
2. DECENTRALIZED UDDS or SATELLITE PHARMACY:
 Define:
 Satellite pharmacy services are the sub- pharmacies which receive their supplies from main pharmacy. In
hospital, where the main sections of pharmacy such as storing, manufacturing, dispensing are separated from
each other it is advisable to develop satellite pharmacies at the nursing station.
 Location of Satellite pharmacy:
 Satellite pharmacies are located on each floor of the hospital. This concept is being adopted in
 very big hospitals which have multistoried separate buildings in a single premises.

24. Advantage and disadvantage of satellite pharmacy
 Advantages of Satellite pharmacy:
1. Availability of pharmacist to the patient and nursing for counseling.
2. Pharmacist at nursing station takes patient drug history and monitor patient for drug reaction.
3. Drug distributed efficiently.
4. Drug distribution time can be reduced.
5. No error in drug distribution.
 Disadvantages of Satellite pharmacy:
1. Additional manpower is required
2 Effect on the budget of hospital.

25. Bed side pharmacy
 Definition
 Personally each pharmacist in the hospital pharmacy department should visits the wards go to the each patient bed
side and discuss with them regarding the medicines and the drugs they take is called as bed side pharmacy.
 Importance of Bed-side Pharmacy
1. The Pharmacist should in inter-professional team of physician, Pharmacist nurses.
2. Pharmacist should personally visits the wards and go to the bed side of each patient.
3. He gives the drug information like their storage and administration and directs the patients regarding use of drugs.
4. He should give counseling to the patients regarding food habits and ways of administration Of drugs.
5. He guides the patients about treatment to continue after discharge and how drug should be store at home avoid
degradation
6. Take Medication history of each patient during the visits.
7. Pharmacist drug therapy advisor he has ability the share health care responsibility with the
physicians.

26. Central sterile services
o A central sterile supply department (CSSD) in the hospital is one which receive used goods, process to
make them sterile.
 Definition of CSSR:
 CSSR is the unit provides professionally supplies & equipment to all specialized department. These
specialized departments includes nursing, operation theatre, pathology & laboratory, maternity
department & clinical.
 The material supplied include syringes, catheter needle Intravenous administration sets, urine collection
Blood collection bags, sterile gauze cotton pads, Suction pump, surgical dressing tray & monitoring
equipment
 Location: it should be centrally located in hospital o near place where bulk supplies are required. Ex.
operation theaters.

27. Layout of CSSD

28. Layout include
1. General clean up area
2. Washing and rinsing area
3. Assembly area
4. Gloves washing, drying, powdering area
5. Gloves packaging area
6. Linen inspection and folding
7. Linen storage
8. Clean area

29. Qualification and duties of hospital pharmacist to
manage CSSD
 Since pharmacy students are exposed to principles of sterilization, accounting and management, the
hospital pharmacist is better qualified to manage CSSD than nurse.
 The pharmacist also has better knowledge of use of product dispensed
 Duties of hospital pharmacist in area of CCSD
 Dispensing and purchase of supplies
 Distribution of supplies towards various departments
 Delivering seminars and arranging the training programs for various groups of personnel's
 Manufacturing of various dosage form in hospital in small lots
 This indicate that the pharmacist should be qualified both by education and experience to supervise
activities of CSSD

30. Administrative patterns of central services.
 There are three different pattern so the administrative structure of the central service departments.
1. Department as part of nursing service: The majority of items dispensed are used by the nurses for
patient care .She should therefore head this department. In INDIA, this pattern is widely accepted in the
hospitals.
2.Department under a pharmacist: On account of his training, the pharmacist is competent to handle the
functions of this department, viz. procurement, storage and distribution of supplies and also the
preparation of various sterile solutions. The pharmacist already performs these functions in the hospital
pharmacy. He, therefore, will find it easy to head this department as well.
3.Department under dual control of pharmacist as well as nurses: Some functions of this department,
like cleaning, packaging and distributing medical supplies and equipment's is better placed in the charge of
a nurse, whereas, the manufacture of sterile solutions is better placed in the charge of a pharmacist.

31. Question bank
A. Define the followings
1. Outpatient
2. Inpatient
3. Unit dose dispensing
4. Central sterile service/CSSR/CSSD
5. Floor stock
6. Bed side pharmacy
B. Give various administrative patterns of central services.
C. Explain Classification of Out patient OR
D. Discuss the term general patient, referred patient, emergency out patient
E. What is bed side pharmacy and satellite pharmacy?

32. continue..
F. Give advantages and disadvantages of mobile dispensing unit.
G. Draw and explain location & layout of central sterile services.
H. Explain the process of dispensing drugs to outpatients in typical hospital.
I. Define bed-side pharmacy. Write its importance.
J. Write advantages of unit dose dispensing.
K. Give requirement of location and layout for outpatient pharmacy.