DRUG DISTRIBUTION OUTLINE PNEUMATIC TUBE METHOD

1. DISPENSING ROUTINE
▶ Prescription written by the
doctor, are taken by the patient
to the pharmacists, the
prescription and the label are
numbered, the directions and
pertinent information are
entered on the label.
conducted and finally
▶ A check for accuracy is
the
container is handed to the
patient giving them directions,
regarding the proper use of the
preparations supplied.
▶ Pharmacists gives information
regarding dosage, frequency
of taking them, mode of using
and precautions.
M
e
rintk

2. IN-PATIENT SERVICES
M
e
rintk
▶ In patients are those who get hospitalised for the purpose of treatment,
cure of disease, surgery or rehabilitation
Objectives of drug distribution system for inpatients are:
1. To provide drugs for all inpatients of the hospitals on a 24 hours per
day basis.
2. To inspect and control the distribution of drugs on all treatment areas.

3. Location Layout And Planning
M
e
rintk
▶ The unit should be such a place in the hospital which is readily
accessible to all departments and free from disturbance.
▶ The various sections of inpatient pharmacy should be continuous.
▶ IP services is in close proximity to the wards.
▶ The unit should be well equipped.
▶ It should be supervised by a qualified pharmacist
▶ The facilities used to store the drugs should be designed in such a way
that it facilitates the routine inspection of the drugs before its
administration and these are readily available to the physician and
pharmacist.

4. Methods of Drug Distribution
M
e
rintk
In a hospital, drug is distributed to the patients by 4 different methods.
1) Individual Prescription Order System.
2) Complete Floor Stock System.
3) Combination Of Above 2 Methods (1And 2.)
4) Unit Dose Dispensing

5. 1).Individual Prescription Order System
M
e
rintk
▶ This system is mostly adopted in very small hospitals having a bed size
of 2 to 5 and private clinics.
▶ Physician writes the prescription for individual patient who obtains the
drug prescribed from hospital dispensary by paying own charges.
▶ medicine is dispensed either by the pharmacist or under his direction.
▶ Dispensed medicine is labelled with individual patients name with
related instructions after receiving the prescription sheets

6. Advantages
▶ All prescriptions are directly checked by the pharmacist.
▶ Medication errors could be avoided.
▶ It facilitates interaction between the pharmacist, the doctors and
the nurses
▶ Close control on inventory is possible
Disadvantages
▶ Difficulty of dispensing in absence of a pharmacist.
▶ This system cannot be used in big hospitals.
▶ Medicines cost may increase.
▶ Delay in obtaining medication
M
e
rintk

7. 2). Complete floor stock system
M
e
rintk
▶ Under this system both the pharmacy and the nursing station are
responsible for the drug distribution.
▶ Drugs are stored at the nursing station and are administered by a nurse
according to the chart order of the physician
▶ Pharmacists checks the consumption on each floor and provides
replenishment stock.
▶ Only commonly used drugs are stocked on the floor
The drugs are of two categories namely
(a) Charge floor stock drugs.
(b) Non- charge floor stock drugs.

8. M
e
rintk

9. Charge floor stock drugs.
M
e
rintk
▶ Charge floor stock drugs can be defined as those medications which are
stocked at the nursing station all the times and are charged to the
patients account after their administration(based on the doses given).
▶ 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.

10. Dispensing of charge floor stock drugs:
M
e
rintk
Envelop method
▶ A hospital develops a method in which an envelop was used to dispense
the drugs to the nursing station and was also used as a charge ticket.
▶ Orders made in triplicate for ward, accounts department and pharmacy
department.
▶ In this system a pharmacist fills pre labelled envelops with the needed
drugs and places a pre determined quantity on the nursing ward.
▶ At the time of administration the nurses writes the name and room
number of the patient on the envelop and puts it in “ outer basket”
▶ It is later sent to the pharmacy where it is précised and forwarded to the
billing section of the accounting office

11. M
e
rintk

12. ▶ Advantages:
┛ Quick availability of medicines
┛ Ease of costing
┛ Reduced pharmacy workload
▶ Disadvantages
┛ Increased potential for ME
┛ Responsibility and risk to nursing personnel
M
e
rintk

13. Non charge floor stock drugs
M
e
rintk
▶ These are the drugs which are kept at the nursing station for the use of
all patients of the wards.
▶ In this aces the cost of the medicine, is not directly added to patient’s
billing.
▶ The medicines cost may be calculated as per the day expenses of the
hospital room.
The stock of such drugs is maintained by considering the following
factors:
 The cost of preparation
 The frequency of use
 The quantity used
 The hospital budget

14. UNIT DOSE DISPENSING SYSTEM
▶ Unit dose medications are those which are ordered, packed, handled
administered and charged in multiples of single dose units containing a
predetermined amount of drug.
▶ In this system a bulk is repacked in a single dose quantity in an individual
pack. All the activities are carried out under the strict control of a
pharmacist.
▶ Asingle unit package is one which contains one complete pharmaceutical
dosage forms.
M
e
rintk

15.  Pharmacist makes each and every dose of medication ready for
administration . Solid medication is pre-packed and labelled for each
patient.
 Strip- packaged tablets which we use are a common example of unit
dose dispensing.
 Drug supplies are received by the medical stores in bulk. Therefore,
making unit doses out of bulk is an important function in hospital
pharmacy. It is useful for dispensing to inpatients as well as to
outpatients
 Unit dose dispensing can be done in a centralised way in a pharmacy or
can be decentralised at the level of a nursing unit.
M
e
rintk

16. METHODS:
M
e
rintk

17. A . CENTRALISED UNIT DOSE DRUG
DISTRIBUTION SYSTEM
M
e
rintk
 All in-patient drugs are dispensed in unit doses and all the drugs are
stored in central area of the pharmacy and dispensed at the time the dose
is to be administered to the patients.
 The delivery of drugs to the patients is made through Medication carts
and dumbwaiters, which carry unit doses to the patients.
 Section tubes (pneumatic tubes) or other mechanised means are required
to convey the physician’s original prescription to the pharmacy for
dispensing.

18. M
e
rintk

19. B. DECENTRALISED UNIT DOSE DRUG
DISTRIBUTION SYSTEM
M
e
rintk
 This operates through small satellite pharmacies located on each
floor of the hospital.
 The main pharmacy is for procurement, storage, manufacturing and
packing.
 Main pharmacy feeds the medicines to the mini pharmacies.
 Medication carts are used for the delivery of drugs.
 Hospital with separate buildings uses this type of drug distribution
system.

20. PROCEDURE:
M
e
rintk
1. Patient profile card is prepared upon admission to the hospital
2. Prescriptions are sent directly to the pharmacists
3. Pharmacists checks the medication orders for allergies, drug
interactions and dosage schedule in consultation with nursing
station.
4. Junior pharmacists picks medication order and place drugs in
cart
5. The medication cart is filled by the pharmacy technician
according to dosage schedule delivery and is checked by the
pharmacist before it release
6. The nurse administers the drugs and make the entry in their
records
7. Upon return to the pharmacy the cart is rechecked.

21. ADVANTAGES:
• Patient receives improved services and are charged for only those doses
which are administered.
• Nurses get more time for direct patient care
• Medication errors are reduced
• More space is available in nursing station by eliminating bulky floor
stock
• It eliminates wastage of drug and pilferage
DISADVANTAGES:
• It requires more space since packaging material increases the bulk of the
dosage forms.
• It requires increased number of skilled personnel in the pharmacy.
• The cost of medication is increased to the patient due to increased
handling charges
M
e
rintk

22. Labelling
M
e
rintk
Labelling ultimately reflects the pharmacy department. The pattern of
labelling is as follows:
1. Name
2. Dosage form
3. Strength
4. Batch number
5. Expiry date
6. Special direction if required

23. Cautionary and advisory labels
M
e
rintk
▶ For external use only – external products, eg: creams.
▶ Not to be taken – liquid preparations- not to be taken by mouth.
▶ Drowsiness warning – should be warned for drugs causing
drowsiness, blurred vision.
▶ Special methods of administration – eg: dissolved in mouth.
▶ Caution in use – preparation may induce photosensitization.
▶ Potential interaction with food.
▶ Potential interaction with other medicine.

24. CHARGING POLICY:
M
e
rintk
▶ The hospital should have uniform schedule for charging of drugs, the
▶ policies can be categorized under several systems like:
• All Inclusive
• APart Inclusive Rate
• The Professional Fee Concept
• Break Even Point Purchase.
• ACost Plus Rate System
• Computerised Pricing

25. DISPENSING OF CONTROLLED DRUGS
▶ A controlled substance is generally a drug or chemical whose
manufacture, possession, or use is regulated by a government, such as
illicitly used drugs or prescription medications that are designated by
law.
Narcotic drugs
Psychotropic substance
M
e
rintk

26. Responsibility - controlled substance
M
e
rintk
Responsibility
• Administrative Head
(Medical
Superintendent/Dean)
Purchase, storage,
accountability, proper
dispensing of bulk
controlled substance
• Chief Pharmacist/
Medical Officer
Proper storage and use at
nursing station
• Head Nurse

27. Prescribing - Controlled Drugs
▶ Written on doctor’s controlled drug order
sheet of the patients chart.
▶ Should be written by a Registered Medical
Practitioner
▶ Prescribing controlled drugs to outpatients:
yes, it can be prescribed and route of
administration and frequency info is added
M
e
rintk

28. Required information:
1. Full name of the patient
2. Address
3. Date
4. Name and strength of drugs
5. Quantity of drug
6. Signature of the prescriber
7. Dose and route of administration.
M
e
rintk

29. Dispensing Of Controlled Drugs
M
e
rintk
 Aseparate register is maintained for controlled drugs.
 Dispensed as per prescription written by a Registered Medical
Practitioner (Narcotic and Psychotropic substanceAct 1985)
 Kept under lock and key
 Delivery from pharmacy to ward by reliable person
 If patient refuse/doctor cancel the drug, nurse should dispose the
drug in sink and record “Refused by the patient” or “Cancelled by
the doctor
 Medical superindent is over all responsible for handling of controlled
drugs, chief pharmacist procures , stores and responsible for proper
dispensing of drugs within the hospital.

30. Pharmacists role in Dispensing of
controlled drugs
M
e
rintk
▶ Only dispense on the basis of a legally valid prescription
▶ Be satisfied that the signature of the prescriber is genuine
▶ Prior to supply, be satisfied as to the identity of the person or bonafide
representative presenting the prescription or collecting controlled drugs
▶ Be vigilant for forgeries or unusual prescribing patterns
▶ Store controlled drugs in a safe manner, in accordance with the relevant
legislation
▶ Record all supplies of controlled drugs in the pharmacy’s controlled drugs
register
▶ Communicate with the medical practitioner if there is any query about the
prescription, or care of the patient
▶ Adhere to national guidelines and refer as necessary

31. ▶ Dispensing of ward supply to patients for home use: No
▶ Dispensing to employees: No
▶ Dispensing of controlled drugs for home use during pharmacy
off-hours: yes can be given from ward stock.
M
e
rintk

32. M
e
rintk