pharmacy practice sem 7 notes unit 2 Dispensing of drugs to inpatients, types of drug distribution systems, charging policy and labelling, Dispensing of drugs to ambulatory patients, and Dispensing of controlled drugs

1. Drug Distribution System in
A Hospital
-Miss Vedika Narvekar

2. Contents
• Dispensing of drugs to inpatients
• Types of drug distribution systems,
• Charging policy and labelling
• Dispensing of drugs to ambulatory patients,
• Dispensing of controlled drugs.

3. Introduction
One of the basic services provided by hospital pharmacy department is drug
distribution.
Drug Distribution system falls into three broad categories:
1. Ward controlled system
2. Pharmacy- controlled imprest{Stored} base system
3. Pharmacy- controlled patient issue system.

4. DRUG DISTRIBUTION
SYSTEM
OUT PATIENT SERVICES IN PATIENT SERVICES

5. Ward basket system which occurs where the ward writes an order to
pharmacy for all drugs it anticipates over a particular time period for
two or three day.
The pharmacy then assembles the order and sends it to the ward without
seeing the original in-patient medication order written by physician.

6. Pharmacy- controlled ward-based imprest systems: In such system, a
defined range of drugs are available in each ward and is managed by
pharmacy staff.
Traditionally, such system has accounted for the distribution of 75% to
80% of in-patient drugs.

7. Pharmacy controlled patient issue system: In this system, the drugs
are issued to the patient rather than the ward and can be classed as unit
dose system is where each dose is delivered by the pharmacy.
1)The drugs are distributed to in-patients in the wards, to the operation
theatre, X-ray and other clinics, through the medical stores.
2)The drugs are distributed to outdoor patients who do not occupy beds
and are not admitted.

8. Dispensing of drugs to In patients
(In patient services)
An in-patient is "admitted" to the hospital and stays in the hospital till he recovers or
is discharged by the doctor.
The patients stay in the hospital can extend from overnight to an indeterminate time,
as in the case of coma patients.
Objectives:-
1)To provide drugs for all in-patients of the hospital on a 24 hours per day basis.
2)To inspect and control the distribution of drugs on all treatment areas.

9. Location Layout and Planning
The unit should be located at such a place in the hospital which is readily accessible
to all departments and free from disturbances.
• The unit should be well equipped.
•The physical plan of this department should be well planned by considering the
future growth of the hospital and to avoid the further modifications.

10. Personnel for In Patient services
Manpower is correlated to the number of beds.

11. The Side Head with types of Drug Distribution System:- For general
hospital Practice four systems are used to distribute drugs from
pharmacy to wards.
1) Individual prescription order (for Each patient) system:- Small and
private hospitals adopt this system since it can be operated with less
manpower, economic considerations and under the direct supervision of
a Pharmacist. Here the drugs are dispensed and labelled for each
individual patient.

12. Advantages
• Reduces manpower
requirement.
•All prescriptions are
directly reviewed by
the pharmacist.
• Opportunity of close
interaction between
the pharmacist, nurse
and physician
• Medication error can
be spotted.
Disadvantages
• Possibility of delay
in obtaining
medication.
• Increases in the cost
of drugs to patients.
• It can't be practiced
in big hospitals.

13. 2)Complete floor or ward stock system:- Under this system, the nursing
station carries both “charge” and “non-charge" patient medication.
According to this system, the drugs are stored at the nursing station and
are administered by a nurse according to the chart order of the
physician.
• Nursing staff from each floor or ward sends their written demands of
drugs according to the list provided to each floor and ward, daily to the
hospital pharmacy herself or through a messenger and collects the
medicines from the pharmacist.

14. Advantages
• These are readily
available for
administration.
• Minimum return
of drugs.
• Reduced in-
patient prescription
orders.
•Reduction in the
number of
pharmacy
personnel required.
Disadvantages
•Increase in chances of
medication errors due to
lack of review by
pharmacists.
• Greater opportunity for
misuse of drugs resulting
in financial loss.
•Increased chances of
drug deterioration due to
lack of proper storage
facilities.
• Increased work load on
nurses

15. The drugs on the nursing station are known as Floor Stock Drugs.
They are classified into two parts
1. Charge floor stock drugs.
2. Non-charge floor stock drugs.

16. Charge Floor stock Drugs
Charge floor stock drugs are those for which the patient is charged for every single
dose administered to him.
•Selections of these drugs in different wards is coded by " Pharmacy and
Therapeutic Committee".
•Once the floor stock list is prepared, then its responsibility of the hospital
pharmacist to make the drugs available.
• Charge floor stock drugs are stored at various nursing stations.

17. When the drug is administered, the patient’s name and room number is
entered on the envelope and sent to pharmacy for records.

18. Non-charge floor stock drugs
Non-charge floor stock drugs are the medicaments that are placed at the nursing
station for the use of all patients on the floor. For these drugs, there shall be no direct
charge from the patients account.
Non-charge floor stock drugs consist of a pre-determined list of medication
available on every nursing unit of the hospital.

19. 'Drug basket method' is
adopted where nurses
check the medicines in
all rooms and in the
refrigerator and prepare a
master list for the
pharmacy.
Nurses fill a requisition
form for delivery of
drugs at their floor.
When there is an empty
container, the nurse
places it in the drug
basket.
Once the procedure is
completed the drug
basket containing the
empty container and
requisition for floor stock
supplies are then send to
the pharmacy.

20. Mobile Dispensary
Unit
It is a specially
constructed stainless-
steel truck measuring
60 inches high, 48
inches wide and 25
inches deep.” It is
mounted on bottom
tires,

21. Combination of individual drug order and floor stock system
This system is used in those hospitals where patients pay for their
hospitalization & the hospitals use the individual prescription order
system as their primary means of dispensing but have several drugs in
the floor stock.

22. Advantages
1. Drug procurement is a one
system so the pharmacy
assistant and patient’s time
can be saved.
2. As per respective medical
specialties and ward units
like cardiology, neurology,
nephrology, etc first line and
follow-up drugs can be
dispensed and refilled
through proper method.
3. Combination leads to better
patient medication
adherence, counselling.
Disadvantages
1. Extra space and cabinets
may be required.
2. Staff pharmacy including
extra framework and
infrastructure is required
hence, budget
requirement is another
typical task.
3. Special care division may
be affected.
4. Storage space may be
required more.

23. Unit dose Dispensing System
• A single unit package is the one which contains one complete pharmaceutical
dosage form.
Ex: One tablet, one capsule 💊, 10 ml oral liquids.
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.

24. Disadvantages
1. It requires more space since packaging material increases the bulk of the dosage
forms.
2. It requires increased number of skilled personnel in the pharmacy.
3. The cost of medication is increased to the patient due to increased handling
charges.

25. CENTRALISED UNIT DOSE
DRUG DISTRIBUTION
SYSTEM (CUDD)
Methods Of Dispensing Unit Doses
DECENTRALISED UNIT DOSE
DRUG DISTRIBUTION SYSTEM
(DUDD)

26. CUDD
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 of the dose is to be given to
the patient.
To operate the system as effective delivery system various medication carts are used
two carry unit doses to the patients.

27. DUDD
This operates through small satellite pharmacies located on each floor of the
hospital.
The main pharmacy is for procurement, storage, manufacturing and packing. It
serves to all satellite pharmacies.
Used in hospital with several buildings.

28. Procedure Followed for DUDDS
✓ Patient profile card is prepared upon admission to the hospital.
✓ Prescriptions are sent directly to the pharmacists.
✓ Pharmacists checks the medication orders for allergies.
✓ Dosage schedule made.
✓ Patient profile card & prescription is filled.
✓ Pharmacist check card prior to release.
✓The nurse administers the drugs and make the entry in their records.
✓Upon return to the pharmacy the cart is rechecked.
This process requires the availability of pharmacist for consultation by doctors and
nursing staff.

30. Charging Policy
The hospital should have uniform schedule for charging of drugs.
The policy can be categorised under several systems like:
➢ All Inclusive
➢ A Part Inclusive Rate
➢ The Professional Fee Concept
➢ Break Even Point Purchase.
➢A Cost Plus Rate System
➢ The Profit Aspect.
➢Computerized Pricing

31. 1) All Inclusive or No Special Rates: This system provides quality pharmaceutical
services and enables hospital to reduce administrative and accounting cost.
2) A Part-inclusive Rate: A pharmacy service charge is implemented.
3) The Professional Fee Concept : This fee concept is "the exclusive professional
fee to meet all operating expenses including overhead and compensation but not
the actual cost of drug and containers".
4) Break Even Point Purchase: It is a useful tool in overall analysis of cost,there is
neither profit nor loss.
5) A Cost Plus Rate System : In this system, pharmacist maintains a better control
using formula:

32. 6. The Profit Aspect: In this, profit is calculated into price to the patient by
following ways:
• A fixed fee per prescription
•Addition of predetermined percentage of the break- even point figure.
7. Computerized Pricing: This system is quite fair and provides computerized on-
line pharmacy pricing. The computer program will ask for only following
information:
• Patient number.
• Drug identification number.
• Dose factor.
• Total number of doses dispensed.

33. Labelling
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.

34. Dispensing of drugs to Ambulatory Patients
Depending on the kind of hospital, ambulatory patients get themselves registered at
registration counter of that hospital. After the registration, consultation with the
doctor finally receives the prescription, the patient goes to the pharmacist to obtain
the medicines.
The various steps involved in dispensing are:
1) While dispensing a prescription, pharmacist should take every precaution to
eliminate errors.
2)If pharmacist needs any clarification about the prescription, he should contact the
physician without the knowledge of the patient.
3) Pharmacist checks the ingredients and collects the materials for compounding
dispensing.

35. 4)The compounded prescription is filled in a counter and labeled with detailed
instructions including; name, gender, age, registratign number for use and storage.
5)The Pharmacist shall maintain a register for the purpose at accounting.
6)Mixtures like ointment, lotion and powders are not recorded while records of
costly drugs like injection, antibiotic; etc. are maintained.
7) Prescription is given back to the patient so that he can produce the same during
his next visit.

36. Dispensing of Controlled Drugs
Controlled drugs are classified in the order of the abuse risk and placed in schedules
by the federal Drug Enforcement Administration. The drug with highest abuse
potential are placed in schedule I (heroin, cocaine) & with lowest abuse potential
placed in Schedule V.
A separate register is maintained for controlled drugs.
Medical superintendent is over all responsible for handling of controlled drugs.
Chief pharmacist procures, stores and responsible for proper dispensing of drugs
within the hospital.
Kept under lock and key.

37. Prescription for Narcotic Drugs must include:
1. Patient's Full name
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.

38. • Delivery of narcotic drugs from pharmacy to the wards must be carried out by
some reliable reliable persons.
• While administering doors give patient refuses or doctor cancels any dose it is the
duty of the nurse to destroy the drug into sink and record “Refused by patient” or
“order cancelled by doctor”.
• Proper records should be maintained.