"The patient which is not admitted in hospital but receiving general or specific treatment is called outpatient."

1. Drug
Distribution
system in
Hospitals
Prepared by:
Ms. Shivanee Vyas
Assistant Professor
SVKM’s NMIMS, School of Pharmacy and
Technology Management 1

2. OUTPATIENT
Classification of Outpatient:
1. General outpatient: The outpatients which are not receiving emergency or
specific treatment are called general outpatients, e.g. diabetic patient,
hypertension patient.
2. Emergency outpatient: The outpatients if receiving emergency treatment or
an accident care are called emergency outpatients.
3. Referred outpatients: If outpatients are receiving specific treatment then
those are called referred outpatients, e.g. patients suffering from eye, ear,
nose, teeth disorders.
4. Ambulatory patient: "An ambulatory patient is able to walk' and since
outpatients receive primary health care and walk off, they are wrongly called
ambulatory patients." Majority of outpatients are ambulatory patients.
"The patient which is not admitted in hospital but receiving general or specific treatment is called
outpatient."
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3. Location of Out-patient Dispensing
• There is no set rule regarding the location of out-patient dispensing area, preferably it should be located on
the ground floor of the building and near to the entrance of the building for easy access by the patients.
• It should be close to the central registration and out-patient departments so that the patient do not find any
difficulty in it’s location.
• The out patient dispensing area should be provided with proper seating arrangement so if long time is needed
for filling the prescription, the patient can wait till the prescription is filled.
• There should be two prescription window, one for men and other for women.
• The out-patient department should be located in such a way that, it should not cause disturbance to the
inpatient.
Racks for storing drug
Refrigeration Dispensary
Office
Windows for dispensing
Seating arrangements for patients 3

4. Dispensing of Drugs to Outpatients in Hospital
• Medicines are given to the outpatients from the pharmacy on the prescription given to them by the consultants.
• Free medicine cases directly get medicines but in payment cases they pay the cash at the cash counter and produce the bill
along with the prescription to the pharmacy.
Process:
1. On entering the hospital, the patient goes to the registration counter, registers his/her name, and gets a case paper with
the name, sex, age, and a number as reference means identity slip, and registration number.
2. On the basis of external symptoms and a few oral questions they are directed to go to a particular department for
consultation.
3. Consultant diagnoses the disease and either prescribe the medicines as such or after referring and getting reports from
clinical laboratory or radiology department.
4. Next, the patient goes to the cash counter and makes a payment.
5. With cash receipt and prescription the patient goes then to pharmacy and gets medicines.
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5. IN-PATIENT
• “An In-patient is one who is confined to a bed or who is occupying a bed in the hospital.”
• The drug distribution to the in-patient department can be carried out from the out-patient dispensing area.
• The in-patient department can be located on the ground floor or first floor of the building but it should be
near the out-patient department and centrally located so that the staff can easily reach there.
• The in-patient dispensing should be carried out by a pharmacist helped by skilled and qualified staff.
• In-patient pharmacy is a multi-function department for storage, dispensing, manufacturing of IV fluids and
Parenterals, etc.
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6. Drug Distribution system to In-patients
• The different methods of drug distribution system to in-patient in hospital:
1. Individual prescription order system
2. Floor stock/ ward stock system
I. Charged floor stock system
II. Non-charged floor stock system
3. Combined individual prescription order system and floor stock system
4. Unit dose dispensing system (UDDS)
I. Centralized unit dose dispensing system
II. Decentralized unit dose dispensing system
5. Satellite pharmacy
6. Bedside pharmacy
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7. 1. Individual Prescription Order System:
• This system is generally used in small and/or private hospitals because of its economic consideration and
reduced manpower requirements. According to this system prescription is received by pharmacist and
medicine are dispensed for in-patients.
• In this system the drug are dispensed and labeled for each individual patient.
• Here medications are kept in nursing unit medication cabinet under the custody of nurse in-charge. Only
nurse is responsible for administering correct medication to each patient inward.
Advantages:
1. All the medication orders are directly reviewed by the pharmacist so that there are less chances of
medication errors.
2. Pharmacist can counsel the patient.
3. Maintenance of record is easy and paper work is minimized.
4. Patient should pay for the medicine which are consumed by him.
Disadvantages:
1. Emergency medicines are not quickly supplied.
2. Delay in receiving medicines.
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8. 2. Floor Stock/ward stock system
• It is a system where drugs are stored at each floor or near to the ward at nursing station.
Method:
1. At the end of the day pharmacist should collect the requisition and empty containers from the various nursing
units.
2. These containers are filled and on next morning the medicines are given to nursing station.
3. This system is followed for 2 to 3 times per week or according to requirement.
Types of Floor Stock System:
I. Charged floor stock: If charged floor stock medicines are given to the patient, cost of those medicines is directly
added to the patient’s account. E.g. Includes costly medicines such as penicillin, streptomycin, quinidine, diuretics,
etc.
• PTC decides charged floor stock drugs and its requirements.
• The selected list of charged floor stock is constantly being reviewed by the PTC for necessary revision.
II. Non-charged floor stock: these medications are stocked on nursing stations at all times. The cost of such
medicines is adjusted in the room rent, e.g. saline solution, dextrose solutions are non-charged drugs, they are
adjusted in room rent.
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Advantages:
1. Waiting period is less so the medicines can be received immediately.
2. Emergency medicines are easily available for quick distribution.
3. Number of pharmacists required for dispensing are reduced.
4. It avoids exercise of patient’s relatives to bring the medications.
Disadvantage:
1. Review of prescription by pharmacist is not possible.
2. Inventory is increased therefore, budget of hospital is increased.
3. Counseling of patient by pharmacist is not possible.
4. Paper work is increased.
5. More space is required at nursing station for stocking medicines.
6. Maintenance cost and wastage of medicines is increased.
7. It increases work load of nurses.
Application:
1. Useful in large hospitals.
2. Helps to check the efficacy of nursing unit.
3. It provides emergency supply of medicines to the patient.

10. 3. Combination of Individual prescription system and Floor Stock System
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• In this system drug which are frequent use are supplied as ward stocks and other drugs are individually
dispensed when required.
4. Unit Dose Dispensing System “UDDS”
• It is the system which consists of dispensing unit doses to the patients containing a predetermined amount
of drug. These unit dose are either stored or distributed from main pharmacy department only.
• The solid ingredients are repacked and liquids are re-measured and unit doses are prepared as per the
requirement.
Types of UDDS
I. Centralized unit dose dispensing system: if the unit doses are dispensed from pharmacy department, is
called centralized unit dose dispensing system.
II. Decentralized unit dose dispensing system: if the unit doses are dispensed from nursing section, is called
centralized unit dose dispensing system.

11. Advantages:
1. Avoid misuse of medication.
2. Review of prescription is possible therefore, medication errors are reduced.
3. Time required for dispensing is reduced.
4. Patient should pay the cost of medicines which are consumed by him.
5. Purchasing cost and budget of hospital is decreased.
6. Accounting become easier.
7. Paper work is less at nursing unit as well as at the pharmacy.
Disadvantages:
1. Separate manpower is required for prepackaging.
2. Separate containers, closures machinery and also space is required.
3. Unit dispensing should be handled by skilled person and supervised by pharmacist only.
Benefits of UDDS:
1. The patient are charged only for those medications which are consumed by them.
2. It reduces the medication error since the pharmacist checks a copy of physical's original order.
3. Patients receive the nursing service 24 hours a day. 11

12. 4. Satellite Pharmacy:
• The main pharmacy centre is called satellite pharmacy and sub-pharmacy centers are located at each floor
and working as substations for satellite.
• They receive their supply from main pharmacy and distribute them to the patients on current basis.
• These pharmacy are managed by clinical pharmacist who is available in his professional capacity for patient
counseling.
Advantages:
1. Review of prescription is possible by pharmacist.
2. Waiting period is decreased.
3. Emergency medicines are quickly available for administration.
4. Drug therapy can be monitored by pharmacist.
Disadvantages:
1. Inventory is increased therefore, budget is increased.
2. Separate space is required for keeping the stock.
3. Number of pharmacists required for dispensing are more.
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13. 6. Bedside Pharmacy:
• It is the drug distribution system in hospital in which drugs are kept near the bed of the patient so the patient
can utilize the drug himself. A bedside pharmacist offers advice regarding the action and uses of frequently used
drugs to the medical and nursing staff. During the ward visit, he can take the feedback from the patient.
• He takes upon the additional responsibility of drug usage and drug information for which he is trained.
• He also monitors the drug use by conducting the pharmacokinetic studies.
Advantages:
1. Professional skill of pharmacist is utilized.
2. Review of prescription, counselling to patient is possible.
3. Control over drug inventory and utilization is easy and done by pharmacist.
4. Bedside pharmacy system improves patient compliance.
Disadvantages:
1. Number of pharmacist required more in comparison with other system.
2. Chances of over misuse of drug by patient.
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14. Central sterile service/central sterile department
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• It is a separate department of hospital providing professional supplies and equipment (sterile or nonsterile)
to all specialized departments.
• The items provided by this department include syringes, needles, gloves, bags for urine collection, catheters,
cotton pads, blood bottles, etc.
• The equipment distributed by this department are suction pumps, cardiac and other catheters, surgical
dressings, trays, monitoring equipment, etc.
• This department is responsible for the distribution of medicinal equipment and the supply of sterilized
materials.
• The central sterile department also takes an active role in developing various sterilization techniques.
• The management of central sterile services is under the control of nursing staff, as one of their duties. But a
trained pharmacist person is more suitable to maintain sterilization of equipment and preparation of
intravenous fluids.

15. • Objectives of Central Sterile Services
1. To maintain a supply of sterile equipment to the operation theatre.
2. Cleaning and sterilization of all hospital supplies.
3. To provide sterile gowns, caps, masks, and hand gloves during operations.
4. To develop a cost-effective program by cost analysis, personal supplies, and equipment.
• Departments Served by Central Services
I. Operation theatre.
II. Recovery room.
III. Intensive surgical care.
• Location of Central Sterile Services.
1. It should be located near the operation theatre.
2. It should be located in such a way that the most rapid transport of material is possible.
3. The department should have the capacity to expand itself if the hospital grows in the future.
4. It should be located near the pharmacy department to have better administrative control.
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16. The layout of Central Sterile Area: The plan of the central sterile room is clearly divided into two areas:
1. Nonsterile material area or "dirty area".
2. Sterile material or "clean area".
Through D2 the material is received by the supply department. Received materials are dissembled or kept in the rack. Whenever
required material is allowed for sterilization, they are kept in the space provided for keeping sterilized materials.
The cross-flow of sterilized and nonsterilized materials is avoided. From W2 the material is dispensed to departments other than
operation theatre, and through W1 sterilized material is supplied to the operation theatre.
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D2
W2 D3
D1
W1
Sterilization zone
S1
S2
1. General clean up
2. Disassembly
3. Adjustment of sets and
kits S1 = Storage of unsterilized
materials.
S2 = Space for storage of sterile
materials.
OT = Operation theatre
D1 and D2 and D3 are doors.
W1 and W2 are windows.
OT

17. Functions of Pharmacist in Central Sterile Area:
1. Purchasing and receiving hospital supplies and equipment.
2. Storage of hospital supplies and equipment.
3. Dispensing and distribution of hospital supplies to various departments.
4. Maintenance and keeping up the records of purchasing, distribution, etc.
5. Standardization and microbial testing of sterilized products should be done.
6. Interacting with other professionals in the health care team.
7. Adjustment of trays for better handling.
Various administrative patterns of central sterile services:
• Nursing services: A nurse should be the head of this department as the majority of items are used by nurses for
patients.
• Pharmacist services: Though the nurse is the head of the department, the pharmacist also performs important
functions, e.g. procurement, storage, distribution of supplies, and preparations of various sterile solutions.
• Correlation between pharmacist and a nurse: Some functions of this department like cleaning, packing,
distribution of medical supplies and equipment should be placed in charge of a nurse whereas the manufacture
of sterile solutions should be placed in charge of pharmacists.
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