Definition, Types of drug distribution systems, Dispensing of drugs to ambulatory (outdoor) patients, Distribution of controlled drug, Novel drug distribution methods

1. Drug Distribution
System in Hospital
Dr. Subhash R. Yende
Asst. Professor
Gurunanak College of Pharmacy,
Nagpur (MS)

2. Introduction
 Physical transfer of drugs from storage area in the
hospital to the patients bedside.
 Dispensing and compounding of prescription
requires scientific knowledge as well as skill and
art.
Drug
Distribution
Out-
Patient
In-Patient
2Dr. Subhash R. Yende GNCP, Nagpur

3.  Involves shipments, inventory control,
invoicing, payment and accounts
 In hospitals, drugs are obtained from
medical store and are supplied to wards,
OT, X-Ray and other dept for treatment of
Indoor as well as Out door patients by
indent system.
 Should prepare SOP for distribution of drug
within the hospital
3Dr. Subhash R. Yende GNCP, Nagpur

4. Types of drug distribution systems
1. Individual prescription order system
2. Complete floor stock system
3. Combinations of individual drug order and
floor stock system
4. Unit dose dispensing system
5. Non floor stock system
4Dr. Subhash R. Yende GNCP, Nagpur

5. 1. Individual prescription order system
 Used in small or private hospitals with lesser
manpower and economic consideration
 It is a type of prescription system where the physician
writes the prescription for individual patient who
obtains the drug prescribed from any medical store or
hospital dispensary by paying own charges.
Advantages:
 All medication orders are directly reviewed by
pharmacist
 provides the better interaction of pharmacist-doctor,
nurse and the patient.
 It provides clear control of inventory.
Disadvantages:
 May delay in obtaining the required medications
 May Increase in the cost to the patient 5Dr. Subhash R. Yende GNCP, Nagpur

6. 2. Complete floor stock system
 Under this system, the drugs are given to the
patient through the nursing station and the
pharmacy supplies from the drug store of a
hospital.
 Drugs on the nursing station or ward may be
divided in to-
 Charge floor stock drugs
 Non charge floor stock drugs
6Dr. Subhash R. Yende GNCP, Nagpur

7. Advantages:
 The drugs are readily available for
administration
 Minimum return of drugs to store
 Reduced in-patient prescription orders
 Reduction in number of pharmacy personnel
required
Disadvantages:
 Increase in chance of medication errors
 Increase in drug inventory in wards
 Increase chances of drug deterioration due to
lack of proper storage facilities and due to
unnoticed drug degradation
 Increased workload on nurses
7Dr. Subhash R. Yende GNCP, Nagpur

8. Charge floor stock drugs:
 Medicines which are stocked on the nursing
station at all times and charged to the patient’s
account after they have been administered to
them.
 Patient is charged for every single dose
administered to him
 Selection of charge floor stock drugs-
◦ Decided by PTC
◦ Drug should be always available as immediate
use drugs of proven efficacy
◦ Necessary to administered to patients
◦ Examples- Anti-allergic, Antibiotics,
antiepileptics, antihypertensive, etc
8Dr. Subhash R. Yende GNCP, Nagpur

9. 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.
 there shall be no direct charge from the patients
account for these drugs
 Methods:
a. Drug basket method
b. Mobile dispensary unit
 Selection of Non charge floor stock drugs-
◦ Consideration is given to cost of preparation, quantity and
frequency of use and effect on hospital budget
◦ Commonly used medicine includes normal saline solution,
dextrose inj., absorbent cotton, antiseptics, disinfectant etc.
◦ Examples – adrenaline, Atropine sulphate, Tin. Belladona,
digoxin, multivitamins, paracetamol, Sodium bicarbonate,
Lidocaine etc.
9Dr. Subhash R. Yende GNCP, Nagpur

10. 3. Combination of individual and floor
stock system
 This system is fallowed in the government and also
in private hospital who run on the basis of no profit
and no loss.
 Individual prescription or medication system is
fallowed as a major means.
 Requirement of drugs or surgical items are given to
the patient who purchase and deposit these items
in hospital wards or rooms under supervision of
registered nurse.
10Dr. Subhash R. Yende GNCP, Nagpur

11. 4. Unit dose dispensing
 Those medications which are ordered , packaged,
handled, administered and charged in multiples of
single doses units containing predetermined
amount of drugs or supply sufficient for one regular
dose, application or use.
 A single unit package is one which contains one
complete pharmaceutical dosage forms
 Ex-one tablet, capsule
11Dr. Subhash R. Yende GNCP, Nagpur

12. 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
 It eliminates labeling mistake, wastage of drug
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 12Dr. Subhash R. Yende GNCP, Nagpur

13. Methods of dispensing unit doses:
A. Centralized unit-dose drug distribution system
(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 the dose is due
to be given to the patient.
 Drugs are transferred from the pharmacy to the
indoor patient by medication cards.
B. Decentralized unit dose dispensing:
 This operates through small satellite pharmacies
located on each floor of the hospital
 The main pharmacy is for procurement, storage,
manufacturing and packing
13Dr. Subhash R. Yende GNCP, Nagpur

14. 5. Charge Non floor stock system
 Semi-automated system to streamline the paper
work involved in charging.
 Save time of supplying the non floor stock drugs
from pharmacy store
 Charge plate system and the envelope system is
used to dispense such drugs
 Charge Plate system: Plastic or metallic card or
plate is prepared for patients identification
 A separate drug form is prepared (in triplicate) and
submit to pharmacy, accounts and nursing unit.
 The envelope system : pharmacist fills a prelabled
envelope with specific quantity of specific drugs
and given to the nursing unit
14Dr. Subhash R. Yende GNCP, Nagpur

15. Dispensing of drugs to ambulatory
(outdoor) patients
Out-patient - patients not occupying beds in a
hospital or in clinics, health centers and other
places
◦ Emergency : A person given emergency or
accidental care for conditions which require
immediate medical attention, suffering from
serious health conditions or illness.
◦ Tertiary care: Directed to OPD by his attending
medical practitioner for specific treatment other
than an emergency treatment.
◦ Primary care: a majority care, used by patients
who are ambulatory i.e are able to move about
freely. 15Dr. Subhash R. Yende GNCP, Nagpur

16. Location of out-patient dispensing:
 It should be located on the ground floor of the
building, provided with proper facility such as
seating arrangement
 May be separate OR combine inpatient and
outpatient unit with service provided from the same
window OR combine inpatient and outpatient unit
with service provided from the different window
16Dr. Subhash R. Yende GNCP, Nagpur

17. Dispensing to out-patient:
 Similar to retail pharmacy store
 Compounded (if necessary) and dispense drug as
per prescription written by physician
 Number the prescription
 Labeling of container or use unit dose form
 Record the prescription detail, quantities supplied
in register maintained for accounting.
 Record of narcotics, poisons, and costly drugs
should maintained
 Give information regarding dosage, frequency,
mode of using, precaution, side effects and storage
condition to patients
 Handle emergency patients prescription, research
program etc
17Dr. Subhash R. Yende GNCP, Nagpur

18. Distribution of controlled drug
 Scheduled X drugs
 These drugs should kept under lock and key
 A separate register should be maintained to
register them
 Record regarding purchase and distribution in
prescribed form by store keeper, pharmacist and
nurses.
 The administrative head of the hospital is
responsible for the proper safeguarding and the
handling of controlled substances within the
hospital
18Dr. Subhash R. Yende GNCP, Nagpur

19. Hospital control procedures:
 Preparation of order : Responsibility for controlled
substance in the
 Order of Doctors for administration of controlled
drugs
 Ordering ward stock controlled substances from
pharmacy
Information on daily controlled drug
administration sheet:
Date, Amount given, Patient’s full name, Patient’s
hospital number, Name of doctor ordering, Signature
of nurse administering, Frequency and route of
administration
Telephonic orders:
Procedure in case of waste, deterioration or
contamination: 19Dr. Subhash R. Yende GNCP, Nagpur

20. Most Commonly Abused Rx Drugs:
 Pain relievers (opioids, narcotics)
 Central nervous system depressants (sedatives,
tranquilizers, hypnotics)
 Barbiturates and benzodiazepines
 Stimulants (used to treat attention deficit disorders,
narcolepsy, and weight loss) Dextroamphetamine
20Dr. Subhash R. Yende GNCP, Nagpur

21. Novel drug distribution methods
Adherence packaging : Strip with individual doses
in individual pouches;
Includes Patient name, Medication name and
strength, Time of administration , Bar cod etc.
Automated dispensing cabinet : a computerized
drug storage device or cabinet; provides proper
storage , inventory control and security for
pharmaceuticals at the point of care; It can be used
only by authorized users who are authenticated by
password
Robotic drug dispensing: The dispensing process
will be paper free as the robot will store the
prescription as soon as a doctor documents it
electronically 21Dr. Subhash R. Yende GNCP, Nagpur

22. Reference
 RK Goyal & RK Parikh. Text book of Hospital
Pharmacy, B S Shah Prakashan Ahmedabad.
 HP Tipnis & A Bajaj. Hospital Pharmacy, Career
Publication,
 https://www.slideshare.net/rajusanghvi1/drug-
distribution-in-hospital-pharmacy
 https://www.slideshare.net/VishwanathAnkola/drug-
distribution-methods
Dr. Subhash R. Yende GNCP, Nagpur 22